Provider Demographics
NPI:1588399950
Name:MORRISSETTE, STAR
Entity type:Individual
Prefix:MS
First Name:STAR
Middle Name:
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 COGLE ST APT A7
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36784-5224
Mailing Address - Country:US
Mailing Address - Phone:334-456-9244
Mailing Address - Fax:
Practice Address - Street 1:625 COGLE ST APT A7
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:AL
Practice Address - Zip Code:36784-5224
Practice Address - Country:US
Practice Address - Phone:334-456-9244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program